Consistency in Standalone Canaloplasty Outcomes Using the ITrack Microcatheter

Overview

Journal Clin Ophthalmol

Publisher Dove Medical Press

Specialty Ophthalmology

Date 2024 Jan 22

PMID 38250597

Authors

Mahmoud A Khaimi

Norbert Koerber

Simon Ondrejka

Mark J Gallardo

Affiliations

Soon will be listed here.

Abstract

Purpose: To study the consistency in outcomes of standalone canaloplasty performed via an ab-interno surgical technique in reducing intraocular pressure (IOP) and number of medications in uncontrolled open-angle glaucoma (OAG) eyes over a 12-month period.

Methods: This retrospective multicenter case series included patients who underwent standalone canaloplasty via an ab-interno surgical technique using the iTrack microcatheter (Nova Eye, Inc., Fremont, USA) and had preoperative uncontrolled OAG (IOP≥18mmHg) along with no previous glaucoma surgery. The iTrack microcatheter is used to circumnavigate 360° and viscodilate Schlemm's canal. Consistency of IOP and medications reduction on an eye-by-eye basis were evaluated to understand the outcomes in each single eye.

Results: Sixty-four eyes of 60 patients (age 71.5±13.4 years) were included. Six eyes (9%) that underwent additional glaucoma surgery were considered a failure and were subsequently excluded from analysis. At 12 months, IOP was reduced in 57 of the 58 (89%) remaining eyes; one eye had the same IOP with a reduced number of medications. Of the 57/58 eyes with a reduced IOP: 44 eyes (69%) required fewer medications; 12 eyes (19%) required the same number of medications. Of these 58 eyes, 78% of eyes had a ≥20% reduction in IOP compared to baseline; 69% eyes had a postoperative IOP ≤15 mmHg, and 86% eyes ≤18 mmHg at 12 months. Forty percent of the eyes were medication-free at 12 months compared to none at baseline.

Conclusion: Canaloplasty performed via an ab-interno surgical technique as a standalone procedure consistently reduced IOP and glaucoma medications in almost all eyes.

References

Guedes R, Gravina D, Lake J, Guedes V, Chaoubah A . One-Year Comparative Evaluation of iStent or iStent inject Implantation Combined with Cataract Surgery in a Single Center. Adv Ther. 2019; 36(10):2797-2810. PMC: 6822971. DOI: 10.1007/s12325-019-01067-5. View

Tripathi R . Aqueous outflow pathway in normal and glaucomatous eyes. Br J Ophthalmol. 1972; 56(3):157-74. PMC: 1208750. DOI: 10.1136/bjo.56.3.157. View

Shingleton B, Pasternack J, Hung J, ODonoghue M . Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma. 2006; 15(6):494-8. DOI: 10.1097/01.ijg.0000212294.31411.92. View

Hann C, Vercnocke A, Bentley M, Jorgensen S, Fautsch M . Anatomic changes in Schlemm's canal and collector channels in normal and primary open-angle glaucoma eyes using low and high perfusion pressures. Invest Ophthalmol Vis Sci. 2014; 55(9):5834-41. PMC: 4165370. DOI: 10.1167/iovs.14-14128. View

Swaminathan S, Oh D, Kang M, Rhee D . Aqueous outflow: segmental and distal flow. J Cataract Refract Surg. 2014; 40(8):1263-72. PMC: 4151118. DOI: 10.1016/j.jcrs.2014.06.020. View

Khaimi M . Long-term medication reduction in controlled glaucoma with iTrack ab-interno canaloplasty as a standalone procedure and combined with cataract surgery. Ther Adv Ophthalmol. 2021; 13:25158414211045751. PMC: 8481718. DOI: 10.1177/25158414211045751. View

Le K, Saheb H . iStent trabecular micro-bypass stent for open-angle glaucoma. Clin Ophthalmol. 2014; 8:1937-45. PMC: 4181749. DOI: 10.2147/OPTH.S45920. View

Wellik S, Dale E . A review of the iStent(®) trabecular micro-bypass stent: safety and efficacy. Clin Ophthalmol. 2015; 9:677-84. PMC: 4404878. DOI: 10.2147/OPTH.S57217. View

Mathalone N, Hyams M, Neiman S, Buckman G, Hod Y, Geyer O . Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. J Cataract Refract Surg. 2005; 31(3):479-83. DOI: 10.1016/j.jcrs.2004.06.046. View

10.

Riaz K, Gill M, Murphy D, Ding K, Khaimi M . Surgical Management of Intraocular Pressure With Ab Interno Canaloplasty in Postkeratoplasty Patients: 12-Month Results. Cornea. 2022; 42(1):52-59. DOI: 10.1097/ICO.0000000000003009. View

11.

Goel M, Picciani R, Lee R, Bhattacharya S . Aqueous humor dynamics: a review. Open Ophthalmol J. 2011; 4:52-9. PMC: 3032230. DOI: 10.2174/1874364101004010052. View

12.

Koerber N, Ondrejka S . Four-Year Efficacy and Safety of iTrack Ab-interno Canaloplasty as a Standalone Procedure and Combined with Cataract Surgery in Open-Angle Glaucoma. Klin Monbl Augenheilkd. 2022; 240(12):1394-1404. DOI: 10.1055/a-1737-4149. View

13.

Samuelson T, Chang D, Marquis R, Flowers B, Sheng Lim K, Ahmed I . A Schlemm Canal Microstent for Intraocular Pressure Reduction in Primary Open-Angle Glaucoma and Cataract: The HORIZON Study. Ophthalmology. 2018; 126(1):29-37. DOI: 10.1016/j.ophtha.2018.05.012. View

14.

Brandao L, Grieshaber M . Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants. J Ophthalmol. 2013; 2013:705915. PMC: 3863473. DOI: 10.1155/2013/705915. View

15.

Gillmann K, Aref A, Niegowski L, Baumgartner J . Combined Ab interno viscocanaloplasty (ABiC) in open-angle glaucoma: 12-month outcomes. Int Ophthalmol. 2021; 41(10):3295-3301. DOI: 10.1007/s10792-021-01891-1. View

16.

Ahmed I, Fea A, Au L, Ang R, Harasymowycz P, Jampel H . A Prospective Randomized Trial Comparing Hydrus and iStent Microinvasive Glaucoma Surgery Implants for Standalone Treatment of Open-Angle Glaucoma: The COMPARE Study. Ophthalmology. 2019; 127(1):52-61. DOI: 10.1016/j.ophtha.2019.04.034. View

17.

Manning D . Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery. Ophthalmol Ther. 2019; 8(4):549-561. PMC: 6858412. DOI: 10.1007/s40123-019-00208-x. View

18.

Pfeiffer N, Garcia-Feijoo J, Martinez-de-la-Casa J, Larrosa J, Fea A, Lemij H . A Randomized Trial of a Schlemm's Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open-Angle Glaucoma. Ophthalmology. 2015; 122(7):1283-93. DOI: 10.1016/j.ophtha.2015.03.031. View

19.

Allingham R, de Kater A, Ethier C . Schlemm's canal and primary open angle glaucoma: correlation between Schlemm's canal dimensions and outflow facility. Exp Eye Res. 1996; 62(1):101-9. DOI: 10.1006/exer.1996.0012. View

20.

Cha E, Xu J, Gong L, Gong H . Variations in active outflow along the trabecular outflow pathway. Exp Eye Res. 2016; 146:354-360. PMC: 4893924. DOI: 10.1016/j.exer.2016.01.008. View